Annual Assembly

Turning Death into New Life- An Easter Tale

In opening the Easter service in my church yesterday, the pastor reminded the congregation that Easter is centrally about turning from death to new life. He pointed out that this is not only about what we, as Christians, believe God did for us through the death and resurrection of Jesus in overcoming death, but a lesson we can use elsewhere in our lives. He reminded us that many in Newtown, our cross-county neighbor, have been able to turn the horror of the death that was visited on them into a focus on new life. They are certainly not in any kind of denial about the pain and suffering they continue to feel, but many have been able to focus on the blessings and gifts that they still have in their lives.

And this example is seen lots of other places in our lives. For those of us who work in health care, we almost daily see patients and their loved ones who are confronted with tremendous suffering. Some become bitter and angry, but others genuinely acquire a greater appreciation for parts of life they had previously taken for granted. What is still unknown is what causes individuals to turn one way or the other. For those of us who are chaplains, we look for what parts of spirituality or religious belief support this kind of resilience and what parts impede it.

In this search, case studies are important. They are each unique of course but they each give us powerful insights into the ways some people live life to the fullest in the face of suffering and death and others give up on life almost completely.

Those of us who attended the recent AAHPM annual assembly were treated to a plenary by David and Deborah Oliver which I, and I know many others, felt was not only highly educational, but awe-inspiring. David has been living with stage 4 cancer. He and Deborah have “gone public” with virtually all aspects of their journey- both the struggles and the triumphs. But what impressed me more than anything else is their determination to live their lives in all the fullness they can muster including family, friends, travel, and each other. They are determined to find joy and fulfillment in their lives and, because they keep looking, they find it in abundance. There have certainly been trials along the way mostly with the medical system which are also instructive and well documented. David is determined to keep control of both his life and his death. His “HOPE” for dying is:

(H) to die in my own home
(O) surrounded by others
(P) pain free
(E) and excited about living

Many of you may already be familiar with David Oliver from his series of YouTube videos. He also has an ebook out called, Exit Strategy: Depriving Death of its Strangeness that is available on Smashwords. Whether you are a veteran in the field who can always learn more, someone just entering health care, or a patient or caregiver yourself, both David’s videos and book are must sees.

George Handzo, BCC, CSSBB
Senior Consultant
HealthCare Chaplaincy

Behind the Scenes of the Annual Assembly

The Annual Assembly, like baseball season, comes and goes quickly. However, the planning is ongoing and takes a year. Prior to the Annual Assembly, there is much discussion past assemblies – the good, the bad, and the mediocre. The opening day of the Annual Assembly for AAHPM and HPNA – is always exciting. Okay, perhaps not as exciting as Opening Day at Fenway Park for the Red Sox, or opening day for the baseball season in general. But still exciting and rewarding. We have the previous stats from other annual assemblies – winning sessions, home run session and speakers, fouls of language and lack of inclusion, and outs of people who promoted something other than palliative care principles. We have a variety of list of players, and a back-up plan for most last minute changes and pinch hitters. It is the time to see everything unfold.

The strategy behinds the conference is a fluid process, a sort of quality assessment improvement process. Discussions include an overview of the assembly, scheduling, team building, and yes, the process. These are ongoing issues but each assembly has a special focus with a theme and the attention to new leaders and new research in the field. Indeed, the plan behind the “The Game” or the Annual Assembly is much like the delivery of palliative care. There is a “general template for evaluation” – the blueprint of the conference. It outlines everything that needs to be done keeping the group in track with tasks and dates. The evaluation also includes review of the abstract submissions; a competitive process. It is important to understand that the level of conference sophistication continues to rise. All accepted abstracts have an average score of 4.5 or above in a rating of 1—5. This has risen significantly even from two years ago when it was around 4.0.

The amount of “advanced care planning” for the Annual Assembly is extensive – with the “goals of care” established in the overall objectives of the meeting: networking, education, and renewal. The “surrogate decision makers” are comprised of the members of Planning Committee. It consists of the Co-Chairs representing HPNA and AAHPM as well as the planning committee members reflecting the diversity of both organizations, the Research Sub-Committee Co-Chairs and their research committee, and the staffs at AAHPM and HPNA. There are constant “family meetings” to provide information of the state of abstracts, plenary planning, conflict of interest, continuing education credits, and the like. There are “decision points” in terms of abstract review and acceptance, content review, and the implementation of new technology into sessions. Above all, there is a “collaborative process” which helps when there are bumps. These include the inevitable technology glitches, communication with abstracts not being accepted, and keeping everyone in the communication loop around decision-making. Thus, there is the philosophy “hope for the best, and plan for the worst” and “promoting excellence.”

Being Co-Chair at the meeting is like being a Baseball Manager. You are in the background working on the process. Then you are in the public domain when it all begins. You are responsible for what occurs at the conference. Since people know who you are, you hear the good and the bad as well as everything in between. People assume you know all the intimate details of the conference, from the telephone numbers of the AV people, to Room Numbers, to session scheduling. To assure confidence in offering up-to-date information and assistance, I carry a notebook with all the conference details. My notebook has an hour by hour, day by day review of the schedule, from the schedule with Title of Presentations, to Presenters, to Room numbers for my reference. I also have my own personal schedule with the events which includes dropping in on preconferences, new speakers, or new technologies. Yes, this may be old school, but I can tell you it is often easier and quicker than getting online access to the conference sessions.

On Wednesday, the pre-conferences are the warm-up or “pre-season” for the Annual Assembly. You get to see your co-collaborators- the national staff from AAHPM and HPNA – whom you have spent many telephone and e-mail hours working with, to check in to make sure everything is ready.The Opening Reception sets the tone; the personal connection. Relationships are renewed with the delight of seeing friends and colleagues. New relationships are established as one puts names to faces of people you have worked with. On Thursday as the Opening Plenary begins, there is a feeling of “Game on-Here we go!” There are a variety of expectations for the day – to be inspired, to explore new areas, and to reconnect. The “season” has begun. On Friday, the “game” is in full swing the conference seems to be full swing, people are in a groove. Difficult choices must be made in terms of which sessions to attend arise, but that is a good thing. We want people to have conflicting choices they want to go to; rather than having a choice by elimination. On Saturday, the tenor is quieter. People have been in full swing for 2 days. They are aware it will end soon and they must say goodbye. An eerie silence begins to descend as participants begin to leave. By the afternoon, “The Game” is over with the sense of “Well played.” There is a bittersweet feeling; one is the sadness of it all ending and the other is a feeling of accomplishment of having achieved education, networking, and renewal. Just like a baseball season, the highs and lows will be discussed and reviewed in detail. Some predictions for the future will occur. But as in all baseball seasons, the hope is that next year, it will be a winner with same energy and enthusiasm.

Constance Dahlin, APRN-BC ACHPN FPCN FAAN
Northshore Medical Center
Palliative Care Services
Boston, MA

A Chaplain Reflects on the AAHPM Conference

Much is properly made these days of the role of spiritual care in palliative and hospice care and the lead role that professional chaplains need to play in that domain of care. Many palliative care teams and professional chaplains have risen to this challenge. The newly released version of the NCP Guidelines makes that standard even clearer. However, I would maintain that, for this integration to fully mature, chaplains need to become more involved in the greater palliative care community just as they need to be involved in the professional chaplaincy community. Put another way, for chaplains to grow their identity as members of palliative care teams, they need to live in the palliative care culture nationally as well as locally.

While there are several options for how to do this, one that has been highly worthwhile for me over the past four years is the American Academy of Hospice and Palliative Medicine (AAHPM) which just concluded its yearly conference. I would immediately acknowledge that there are several barriers to chaplains being involved here- mostly involving money and time. Dues and attendance at the conference are expensive by chaplaincy standards although I do run into chaplains attending AAHPM whose way is being paid by their teams. And the time to go, especially if one is also attending one’s professional chaplaincy association meeting, often winds up cutting into vacation time. Thus, I’m not claiming that this integration will be easy to accomplish. I am claiming that unless we find ways over these barriers, the continuing integration of spiritual care and chaplaincy care into palliative care will be seriously impeded.

Some of what chaplains might imagine as barriers are not. Two “barriers” I know some chaplains presume are “This is an organization mainly for doctors so I won’t be welcome there” and “There will be no content at the meeting relevant to my work”. Both of those assumptions are decidedly false. Remember- these are palliative care and hospice people. By and large, they appreciate and welcome the inclusion of the spiritual dimension of care. And this is a very large organization so the range of offerings in any one time slot at the conference is very wide and deep. My problem in most time slots is picking between the several offerings I want to go to.

The number presentations involving chaplains is still small but increasing. I’ve been part of a team that has presented a very popular pre-conference seminar for the past four years. Tim Ford (VCU), Edie Meyerson (Mt. Sinai-NYC), and this year Terry Irish (City of Hope) and Denise Hess (Providence Health, Torrance, CA) have all made excellent contributions. One of the interesting parts of AAHPM culture is that it is almost impossible to get a workshop accepted unless there are presenters from more than one discipline. This supports the value placed on team work in palliative care. For chaplains, this means that the place to start if you want to present is to talk to your team and be part of a team presentation or a presentation with at least one other member of your team. This year Terry presented with a social worker and Denise with a physician from their respective teams. Note- the deadline for workshop submissions for next year’s conference in San Diego is April 19th. Now is the time! You don’t have to be a member to submit.

Another feature of AAHPM is that it heavily promotes social media. Even if you are not an AAHPM or NHPCO member you can follow various palliative care and hospice blogs and tweets. Pallimed and GeriPal are two of my favorites along with following AAHPM itself and palliative care luminaries like Diane Meier on Twitter. These will give you a good sense of the conversation and hopefully incent you to respond or comment occasionally. This is a major way the voice of chaplaincy and spiritual care is more often heard in the conversation. And it only costs a little time! I recently signed up to contribute to the AAHPM blog itself again to get the chaplaincy voice into the conversation.

For me the highlight of this AAHPM conference was the official release of the 3rd edition of the Clinical Practice Guidelines for Quality Palliative Care from the National Consensus Project which is a consortium of the major palliative care and hospice groups in the US. The guidelines can be downloaded free at www.nationalconsensusproject.org. Notably, Domain 5 (Spiritual, Religious, and Existential Aspects of Care) is tremendously expanded with significant chaplaincy input. The guidelines present powerful evidence for the necessity of professional chaplaincy on these teams. This set of guidelines is now the standard for palliative care and hospice teams and will hopefully become incorporated into the advanced certification standards for the Joint Commission as the 2nd edition was.

So, talking to each other as chaplains is essential. But if those are the only conversations we have, we are in danger of remaining pretty insular as a profession and worse, spiritual care will not be fully present in palliative care. We have to find a way!

George Handzo, BCC, CSSBB
President, Handzo Consulting

Another Amazing Assembly

Everyone knows that I look forward to the AAHPM & HPNA Annual Assembly the way a child eagerly awaits Christmas. There are so many things happening at any given time that there is never a dull moment. I’m also very lucky because I think that we have the most compassionate, enthusiastic and wonderful attendees. When among them I instantly feel like I am surrounded by family. This year I was excited to be working in a new position and I would be doing a variety of new things at the Assembly.

I had the privilege of managing the scholarship program for physicians in developing countries. Through this scholarship the Academy was able to bring 6 physicians to the Assembly. The stories about what these amazing people are doing in their communities are truly inspiring. Over the course of several months leading up to arriving in New Orleans I was able to get to know them all. They are some of the most remarkable people that I have ever met.

During the plenary sessions I sat behind the curtain while coordinating the questions that were being asked through Twitter. The amount of coordination and skill that goes in to making the presentation appear seamless is mind boggling. There are scripts that need to be written, slides have to be shown, videos coordinated, lights maneuvered, cameras positioned and a (very complex) control panel has to be manned. I was in awe of the production guys and our staff. They made it look so easy.

Being at the Assembly this year granted me the opportunity to meet many members and volunteers that I communicate with over social networks in person for the first time. It is such a strange but wonderful feeling to meet someone in person that you already know. At times I found myself skipping formal introductions opting for a big smile and saying “It’s so great to finally meet you!”


While I’m sad that the Assembly is over for 2013 I am looking forward to San Diego. The countdown has already begun!

Jen Bose
Marketing & Membership Coordinator

Spiritual Assessment Tools

At one of the workshops this morning, a speaker made the statement that chaplains were using scripted and particularized spiritual assessment “tools” that may project the chaplain’s assumptions and block the particular expression of the patient’s spirituality. When I sought to correct that assertion during the Q&A, I was told by one of the speakers and several members of the audience that I was incorrect.

The facts of the case are as follows. The standard definition of “spiritual assessment” used in professional healthcare chaplaincy in North America is.

A more extensive [in-depth, on-going] process of active listening to a patient’s story as it unfolds in a relationship with a professional chaplain and summarizing the needs and resources that emerge in that process. The summary includes a spiritual care plan with expected outcomes which should be communicated to the rest of the treatment team.

Fitchett, G., & Canada, A. L. (2010). The Role of Religion/Spirituality in Coping with Cancer: Evidence, Assessment, and Intervention. In J. C. Holland (Ed.). Psycho-oncology, 2nd Edition. New York: Oxford University Press.

This definition clearly does not support the use of a “tool”. This does not mean that no chaplain uses a tool. It only means that this use does not conform to best practice.

There certainly is a substantial lack of clarity here.

The Joint Commission and others do suggest a spiritual assessment. They do not require over even suggest the use of a “tool” which means that the definition above works. Any groups who are requiring the use of a tool are misreading the standards.

The fact is that several institutions that I know of have received advanced accreditation in palliative care without a spiritual assessment “tool”. One of those received a perfect score.

There is a widespread misunderstanding between spiritual “screening”, “history”, and “assessment” tools. For instance, FICA and HOPE are history tools, not assessment tools. They are not recommended for use by chaplains.

At the end of the day, there is a lot of misinformation out there on this topic. I would hope that practitioners would read the regs closely and draw their own conclusions about what is and what is not actually “required”.

George Handzo, BCC, CSSBB
President, Handzo Consulting

A Quiet Place and Labyrinth Room 215

This is my second AAHPM-HPNA conference and I have gravitated to the Wounded Healer talk both years. The care and treatments we provide to our patients and loved ones, can take a toll on us as providers. But as Henri Nouwen states our woundedness we can become a source of life for others.

I provide primary and specialty care to persons with ALS, their loved ones and caregivers. I have been the one to provide comfort and guidance. This year death became significant as I lost my mother three weeks ago. When loss becomes personal, everything changes. The daughter, nurse and individual all wrestled with the lack of control over all of it.

I completed a palliative care certificate course at the University of Colorado School of Nursing this past year. The academics of the course and the support of my colleagues helped me through my mother’s subsequent death. I also realized how little information on Palliative Care with Parkinson’s disease exists.

As I sit through the Plenary Session Friday morning “Our Exit Strategy: Denying Death its Strangeness” David Oliver and Debra Parker Oliver I am learning how death has become a teaching moment, at teaching us how to live.

We must take time to read, research, ask questions, reflect, pray, and support and talk to each other. Communication is the key. This George Bernard Shaw quote is at the bottom of all my e-mails: “The biggest problem with communication is the illusion that it has taken place.”

I never knew that Palliative Care would be my passion. But you only get one chance to die well…so let’s do it well.

Patricia Reisinger MS, CRRN, FNP, GNP
Nurse Practitioner
Spinal Cord Disorders Clinic – ALS
Denver, CO

POTENTIAL ENERGY. ACTIVATION. KINETIC ENERGY.

Some time ago, my AAHPM teammate (and social media maven) Jennifer Bose asked me if I’d write a blog post on my experience at the Assembly today. I’d be lying if said I was anything less than brimming with excitement about the prospect. You see, this is my second Assembly as a member of the AAHPM staff, and my first came just about a week after I was officially hired last year. Because I was brand new, I was able to experience Denver as an attendee might. I was given cart blanche and attended whatever session or meeting I desired. I saw everything. I met everyone. It was staggering and remarkably educational.

It was also decidedly different than my experience this year.

This year, I have been static, essentially posting up permanently at the Resource Center Advocacy Kiosk (you should check it out!). And, if I’m going to be honest, I have to say that I was a little worried about how my perception of this year’s Assembly might stack up after the exhilaration of last year’s. And if I’m going to be even more honest, I was really, really worried about identifying something interesting to put in a blog post. On its face, my activity at the Assembly thus far has really just amounted to sitting on a stool, behind a desk.

Fortunately, I was reminded today why the phrase “on its face” exists. It is a nod to the simple, yet essential truth that life must be lived to be understood, a warning against prejudgment. I was shown again that this Academy and the members who volunteer their time are, fundamentally, deeply dedicated to the field. I was shown again that I am lucky to work for such a special group of people, that hospice and palliative medicine practitioners are not like other providers.

Where policy and advocacy conversations at other specialties’ annual meetings may focus on increasing reimbursement or protecting turf, HPM practitioners seem to have one, core consideration in the issues they hold dear – the quality of care and life for patients and families facing serious illness. Almost every conversation I had with Assembly attendees today focused on what can be done to increase access to hospice and palliative medicine, to assess and improve the quality of care, to express to health policymakers and health system administrators how hospice and palliative medicine is systemically beneficial, and to increase the HPM workforce. Unsurprisingly, the focus was always outward, always on the needs of others.

I feel sometimes that a part of my job is to fret. The scope of policy activity at the state and federal level is daunting, and the list of areas in which I feel a responsibility to help AAHPM members make an impact seems to grow exponentially. Maybe this is a natural feeling in the information age, with its unsettling ability to turn unknown unknowns into (the far more frightening) known unknowns, but it’s unpleasant nonetheless.

Fortunately, though, I have an antidote – action. I always feel better when we are advancing the ball on an issue. I love listening in on a Public Policy Committee call or helping a member draft a letter or developing a project outline. I love it. It is the only way to turn those known unknowns into known knowns, and working with known knowns is really the only way to get your hands around an undertaking as vast as the one facing hospice and palliative medicine.

And that’s what I saw today – I saw the genesis of that action. I saw people who have been involved in advocacy for years, people who are just beginning and filled with all the zeal you’d expect, and I saw people who are primed and already planning how they are going to step up and advocate for their field. So, even though I was static pretty much all day, I was in the middle of a huge amount of activity. It was a cycle of sorts – Potential energy. Activation. Kinetic energy.

Patrick Hermes
Manager, Health Policy & Advocacy

Release of NCP Guidelines, 3rd edition

The release today of the 3rd edition of the NCP Guidelines was a wonderful occasion for everyone involved in palliative care, but especially for chaplains. While the palliative care model emphasizes all four dimensions of care- physical, emotional, social and spiritual, it is often the case that the spiritual dimension is neglected in practice. As Betty Ferrell said today, if you are not doing exceptional spiritual care, you are not doing palliative care. The point here is that lots of institutions are claiming to do palliative care without any kind of spiritual care- let alone spiritual care that could be called exceptional.

There are multiple causes of this situation. In general, health care providers are least comfortable dealing with the spiritual dimension of care. It is also clearly true that there is less evidence for the efficacy of spiritual care in the palliative care process than for any of the other domains. Finally, chaplains themselves have contributed by often being unwilling to be team players and be accountable for their practice to a team. Connie Dahlin was correct today when she emphasized the point of how training for palliative care teams has progressed by emphasizing that even chaplains now have certification in palliative care. As usual, we are the last to the party.

The new guidelines give all of us, but especially spiritual care providers, new “evidence” to support our contention that spiritual care should be a full partner in palliative care. Domain 5 which covers spiritual, religious and existential care has been vastly expanded to reflect the results of the National Consensus Project in 2009 and other efforts. The professional chaplaincy organizations in the US have responded by endorsing these guidelines. On behalf of professional chaplains and all who value the spiritual dimension of care, thanks to Betty Ferrell, Connie Dahlin, Diane Meier and the whole task force for their efforts on behalf of the care of the spirit.

George Handzo, BCC, CSSBB

Feeling Sick?

I was sitting in the airport ready to board the plane to New Orleans yesterday and felt ill. OMG I realized I had been masking several symptoms for over a week. This was my first trip to NOLA I couldn’t be sick! Quickly I started web surfing for urgent cares and pharmacies near the Convention Center. All of these locations were less than a one-mile walking distance.

Concentra Urgent Care
318 Baronne Street
New Orleans, LA 70112
504-561-1051

Walgreens
900 Canal Street
New Orleans, LA 70112
504-568-1271

CVS Pharmacy
800 Canal Street
New Orleans, LA 70112
504-528-7099

I feel better now. I hope you all stay well during your visit during the AAHPM and HPNA Annual Assembly.

Patricia Reisinger, MS, CRRN, FNP, GNP
Nurse Practitioner
Spinal Cord Disorders Clinic- ALS
Denver, CO

Behind the Scenes: Lessons in Leadership, Part I: Dancing with Doctors

As I write this post, the AAHPM & HPNA Annual Assembly hasn’t officially started, but I learned important lessons in leadership today. Some I anticipated – others were unexpected – but when I reflect on my day, here’s one that sticks with me (I will share another soon).

I had the opportunity to sit in on a portion of a special pre-course offering entitled, “You’re Not Just a Doctor Anymore: Finding Influence Through Effective Physician Leadership.” This session was sponsored by the AAHPM Leadership Development Committee and the American College Physician Executives (ACPE). The facilitator, Kevin O’Connor, shared a YouTube video featuring an unemployed guy named Matt who set out to do something simple – travel the world and videotape himself dancing at various locations where he visited. Matt’s 14 months and 42 country journey was later edited into a powerful 4 minutes video entitled, Where the Hell is Matt? which has now been viewed by more than 45 million people via YouTube. Since that time, he has returned to many of the same countries to dance again, this time, however, he has replaced his folksy stomp with more culturally appropriate steps taught by locals (see his 2012 video montage for more of Matt dancing, also available on YouTube).

What do Matt’s travels and this unexpected Internet dance sensation have to do with physician leadership? Quite a bit, it turns out – at least according to the pre-course participants. O’Connor suggested dance is a metaphor for leadership and influence which generated an interesting discussion among session participants. Some of the conversation centered around the following concepts and reflections:

· Doing something simple can inspire other to join in – it’s contagious
· Actions motivate; words aren’t always required
· What you set out to do may result in something positive and bigger than you imagine
· There is much to be learned from others if and when we take the time to watch and listen

This prompted further thoughts:

· Who is the “Matt” in your work environment?
· Does this person realize the impact he or she is having?
· How does this apply to the work of physicians in hospice and palliative medicine?
· Does our “happy dance” attract others? Is it sustainable? Does it inspire others to join in?

Sometimes the simple things we do reach people in ways we don’t expect. So keep on dancing.

Steve Smith, CAE
Executive Director/CEO
American Academy of Hospice and Palliative Medicine (AAHPM)